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� � CITY OF ORONO * z 0 1 3 - PJ 1 2 2 8 * <br /> 2750 KELLEY PARKWAY pAT� ISSUE�: 11/19/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3210 GRAHAM HILL RD <br /> PIN : OS-117-23-11-0009 <br /> LEGAL DESC : GRAHAM HILL PRESERVE-2 <br /> : LOT 1 BLOCK 2 <br /> PERMIT TYPE : PLUMBING (>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURES- MULTIPLE <br /> NO"I'I?: (1)WA"I�GR SOI�"CEtiF.R,(1) R.O. AND(1)IRON P <br /> VALUATION OF PLUMBING 4800 <br /> APPLICANT PLUMBING FIXTURE FEE 60.00 <br /> CLEARWATER SYSTEMS, INC. STATE SURCHARGE PLBG(VALUATION) 2.40 <br /> 1519 148TH AVE NW <br /> ANDOVER, MN 55304 TOTAL 62.40 <br /> (763)434-0445 <br /> Minnesota State License#: 61240 <br /> OWNER <br /> MESENBURG, MATT& MICHELLE <br /> 2525 KELLER ROAD <br /> LONG LAKE, MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work fbr which this permit is issued shall be performed accordi�ig to <br /> the approved plans and specitications,applicable City approvals;and the <br /> State[3uilding Code. This permit is for only thc work described and does <br /> not gr�nt perniission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinances governing this type of work <br /> shall be compied with whether or not specified herein.This permit will <br /> expire and become null and void if construction authorized is not <br /> commcnced within 180 days of the date of issuance,or if construction is <br /> suspended for a period of 180 days at any time after work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested�n contbrmance with the State I3uilding Code.This permit may be <br /> rev � at any ti Y'or due cause. <br /> i� i � / //�/� <br /> pplicant Permitec Signaturc Date Issue By Signature Date <br /> SEPARATE PERMITS REQU[RED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />